Osurnia

RE: Osurnia

spenturn — Thu, 31 Aug 2017 13:06:47 GMT

[quote user="Martin Atkinson"]

[quote user="Michael Woodhouse"]You can achieve such high concentrations with local application in the ear, a disc diffusion based 'resistance' is pretty damn meaningless. This is the main reason we don't culture ears.[/quote]Are you really happy to apply that logic to a dog with pseudomonas?!

[/quote]

Osurnia isn't supposed to be used for pseudomonas. It's in the data sheet.

I've had fantastic success with Osurnia, using it where I'm supposed to, in OE cases causes by malassezia or staph.

RE: Osurnia

Anthony Todd — Sat, 01 Jul 2017 10:59:57 GMT

[quote user="Lucy Fleming"]I know you prefer pulse treatment with steroids,[/quote]

Sorry just seen your reply.

"Pulse treatment" was for skins as opposed to ears. Ears always got a week of topicals and an initial injection of short acting steroid, then checked in a week.

BITD, ears were something like 7% of consults and skins 10.4%!! [crap flea control!!]

I think a significant difference might be that I [and all dinovets, AFAIK] always plucked the ears, if needed, on first visit which seemed to help.

Pulse treat of skins is, IMHO, the obvious way to go as, with a "course, tapered or not, you wouldn't know if your allergen elimination was working.

Often, because of that elimination [fleas, of course, back in the day!] further oral dosage was reduced, or not necessary.

Most owners seemed to find it easy [not all, I agree....]

With any sort of continuous dosage you wouldn't know if your allergen "trial" was effective or not because any relapse would be masked by the continuing steroid.

Pulse dosing would calm the current steroidophobes too......

RE: Osurnia

Lucy Fleming — Thu, 29 Jun 2017 14:36:36 GMT

Sorry Anthony Todd, I didn't mean to post and then disappear. Perhaps ironically,

[quote user="Anthony Todd"]It's always a bug that happens to be living happily, causing no trouble, but apprehended at the scene whilst taking part in the feeding frenzy and multiplication of excess exudation, a bit like Glastonbury.[/quote] I was at Glastonbury festival![quote user="Anthony Todd"]

[quote user="Lucy Fleming"]We differ a bit on our treatment of the underlying allergic disease.[/quote]

You show me yours then; everyone has seen, or can guess, mine........

[/quote]

I know you prefer pulse treatment with steroids, I haven't found that to be as useful - I usually find owners don't re-present for the next 'pulse' until a large amount of secondary damage has been done. In some animals the frequency required would be frustrating and not cost effective for the owners either. I prefer a systemic anti-pruritic (glucocorticoids or apoquel), usually starting BID then reducing to the lowest dose that prevents the relapse of pruritis (often a much lower dose than that required to treat pre-existing pruritis and inflammation). That's a simplification, but for the more chronic/ repeated cases, that is what I find to be the most useful. +/- long term use of regular cleaning, depending on the case.

RE: Osurnia

Gillian Mostyn — Fri, 23 Jun 2017 10:50:34 GMT

[quote user="robloxley"]If we get multidrug resistant psedomonas otitis I will often go for topical application of injectable enrofloxacin[/quote]

I am not criticising your clinical choice of antibiotic, but this did make me smile. There does seem to be a 'trend' for doing this, which is justified on culture results. However, others seem to be worried about using florfenicol (a drug which is not really used in humans) while the use of fluoroquinolones in ears, even off-licence, is pretty widespread!!! Go figure...

RE: Osurnia

Michael Woodhouse — Thu, 22 Jun 2017 22:25:27 GMT

[quote user="Martin Atkinson"]Are you really happy to apply that logic to a dog with pseudomonas?![/quote]

What, that in vitro resistance doesn't = in vivo resistance - yes. I'd guess most of these difficult ears have pseudomonas and some of them we take off all antibiotics and alternate Epiotic cleaning and Cortavance spray. I can't remember ever putting a fluoroquinolone in an ear. Bad, stenotic, ear canals get a short course of pred at a decently high dose (1mg/kg).

I don't believe that the 'infection' is the primary issue. I don't believe you could simply inoculate the infection into another ear.

RE: Osurnia

Anthony Todd — Thu, 22 Jun 2017 20:41:43 GMT

[quote user="Beats"]Creams also get a bit messy with hirsute ear canals -[/quote]

Don't vets pluck ear canals anymore? Surprisingly painless [if you're in the canal....] and the hair, crud and gunk you can get out is amazing, all without local let alone a GA, just a pair of robust artery forceps, or a finger and thumb.

[quote user="Beats"]I think it is interesting to consider the concept of virulent and non-virulent strains rather than assuming all blame lies solely with the host.[/quote]

Surely someone has applied Koch's postulates and produced disease rather than the modvet approach of assuming a pathogen is present, and vigorously treating it, 'cos it is found in a swab or in a urine sample......?

As far as I can see the host is never blamed now. It's always a bug that happens to be living happily, causing no trouble, but apprehended at the scene whilst taking part in the feeding frenzy and multiplication of excess exudation, a bit like Glastonbury.

RE: Osurnia

Beats — Thu, 22 Jun 2017 20:13:07 GMT

[quote user="Anthony Todd"]steroid creams[/quote]

fine for erythematous pinna, but i personally prefer formulations with low viscosity that can be dripped into ear canal for stenosed/erythematous horizontal canal.

Creams also get a bit messy with hirsute ear canals - improved ventilation and lower humidity reduce microbial overgrowth I reckon and creams don't help with that.

[quote user="Anthony Todd"]Would I be correct in saying that most otitis externa starts off with a simple irritation leading to exudate and de dum de dum de dum..... ie pdeudomonas and malessezia aren't primary pathogens at all.[/quote]

That would be the party line. Re malassezia I think it is interesting to consider the concept of virulent and non-virulent strains rather than assuming all blame lies solely with the host.

RE: Osurnia

Anthony Todd — Thu, 22 Jun 2017 20:02:20 GMT

Why doesn't anyone advocate use potent human steroid creams anymore instead of trying to get a "potent" spray into a dog with a really sensitive ear? There are many, just search, even the plebs' Google

Would I be correct in saying that most otitis externa starts off with a simple irritation leading to excess exudate and de dum de dum de dum..... ie pdeudomonas and malessezia aren't primary pathogens at all.

Is it possible to produce otitis externa experimentally with bacteria or yeasts only and no irritant?

RE: Osurnia

Beats — Thu, 22 Jun 2017 19:15:51 GMT

[quote user="Michael Woodhouse"]Have used Cortavance spray in ears to good effect[/quote]

I've never been wholly satisfied with cortavance in ear.

Do you:

1) spray into ears / on pinna?

2) take lid off, draw up 2 x 1ml syringes of 0.1ml or whatever, put lid on and then administer to dogs ears

3) decant a smaller volume into a dropper bottle or something of that ilk?

4) some alternative cunning plan I haven't tried yet!

The price also puts me off.

Any immediate thoughts on Recicort ear drops (Animalcare / Le Vet Beheer) due to launch in Autumn as an alternative to cortavance / colvasone administered topically / maxidex etc? If in a sensible bottle and reasonably priced, I'd have thought this might become a firm favourite?

https://www.vmd.defra.gov.uk/ProductInformationDatabase/SPC_Documents/SPC_1151650.DOC

RE: Osurnia

Rob Loxley — Thu, 22 Jun 2017 17:23:53 GMT

[quote user="Martin Atkinson"][quote user="Michael Woodhouse"]You can achieve such high concentrations with local application in the ear, a disc diffusion based 'resistance' is pretty damn meaningless. This is the main reason we don't culture ears.[/quote]Are you really happy to apply that logic to a dog with pseudomonas?![/quote]

If we get multidrug resistant psedomonas otitis I will often go for topical application of injectable enrofloxacin in trizEDTA (usually plus dex), despite the culture saying resistant. However if said case was sensitive to gentamycin, then I'd probably reach for the Easotic 1st.

RE: Osurnia

Martin Atkinson — Thu, 22 Jun 2017 16:42:10 GMT

RE: Osurnia

Michael Woodhouse — Thu, 22 Jun 2017 14:38:46 GMT

[quote user="Martin Atkinson"]culture showed resistance to florfenicol so it would have been contraindicated anyway.[/quote]

You can achieve such high concentrations with local application in the ear, a disc diffusion based 'resistance' is pretty damn meaningless. This is the main reason we don't culture ears.

(Have used Cortavance spray in ears to good effect)

RE: Osurnia

Martin Atkinson — Thu, 22 Jun 2017 14:01:38 GMT

[quote user="Julie Innes"] Last time the rep was in she was trying to push for us to use it more as a first line treatment, and I'm sure she said it was a narrow spectrum antibiotic?[/quote]Like the Zoetis rep pushing Convenia injection to boost sales with little regard for the greater picture. As I've already said, the cases where I would have used it in aggressive/difficult dogs the culture showed resistance to florfenicol so it would have been contraindicated anyway.

[quote user="Julie Innes"]I always take time to show the client how to apply them and show them the model of the ear, so they can understand what they are trying to achieve with the drops (ie, not a "drop" in each ear). I find dogs often get a bit of relief from the drops and subsequent ear massage. [/quote]Wot she says.

RE: Osurnia

Julie Innes — Thu, 22 Jun 2017 09:03:29 GMT

I've used osurnia and had good results, mainly use it in those dogs who have pathetic owners who can't possibly apply drops themselves (you know, the same ones who shake their head emphatically if you mention tablets- "Oh no, he CANT take tablets" ) Last time the rep was in she was trying to push for us to use it more as a first line treatment, and I'm sure she said it was a narrow spectrum antibiotic?

I don't know if its just me being old-fashioned, but I prefer daily ear drops. I always take time to show the client how to apply them and show them the model of the ear, so they can understand what they are trying to achieve with the drops (ie, not a "drop" in each ear). I find dogs often get a bit of relief from the drops and subsequent ear massage. But osurnia is good for the But-I-cant/ He-wont-let-me owners, and for the psycho small dogs who would in fairness try to eat their face if they tried!!

RE: Osurnia

Rob Loxley — Wed, 21 Jun 2017 20:43:03 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]Ear mites must be really quite rare these days with the introduction of modern insecticides?[/quote]

Yes - I don't see them very often at all these days, compared with very frequently 20 years ago.

[/quote]

I would say we almost exclusively see them in puppies and kittens at 1st vacc/presentation

RE: Osurnia

Gillian Mostyn — Wed, 21 Jun 2017 16:57:16 GMT

[quote user="Anthony Todd"]Ear mites must be really quite rare these days with the introduction of modern insecticides?[/quote]

Yes - I don't see them very often at all these days, compared with very frequently 20 years ago.

RE: Osurnia

Bob Russell — Wed, 21 Jun 2017 16:36:01 GMT

If you have to go looking for it, you have a normal ear. If you have to look between them to find bacteria then it is a problem.

RE: Osurnia

Anthony Todd — Wed, 21 Jun 2017 15:54:51 GMT

[quote user="Lucy Fleming"]In full agreement about the underlying cause in the majority of these (allergy... see mites less often. Due to the popularity of Stronghold/ Advocate etc for routine parasite prevention?). We differ a bit on our treatment of the underlying allergic disease.[/quote]

Ear mites must be really quite rare these days with the introduction of modern insecticides??

[quote user="Lucy Fleming"]We differ a bit on our treatment of the underlying allergic disease.[/quote]

You show me yours then; everyone has seen, or can guess, mine........

Question: in any early "otitis" of any cause do you ever not find malassezia?

How often is malessezia not found in a normal ear?

RE: Osurnia

Lucy Fleming — Wed, 21 Jun 2017 11:57:54 GMT

[quote user="Anthony Todd"]

I'll bet you'll never get "otitis externa" in a normal dog's ear just by squirting a culture of malazzesia into the canal of a normal dog......and probably not with a culture of pseudomonas either.

Irritate it with mites or allergy, increase the production of "wax"; all the bugs shout for joy and multiply like crazy and we've got otitis externa....

Yippe, at least £100plus with a swab, and microscopic instead of a single shot of steroid and some steroid cream [and kill the mites, just in case].

Short explanation about allergy wouldn't go amiss either.....

[/quote]

In full agreement about the underlying cause in the majority of these (allergy... see mites less often. Due to the popularity of Stronghold/ Advocate etc for routine parasite prevention?). We differ a bit on our treatment of the underlying allergic disease.

RE: Osurnia

niall morton — Sat, 17 Jun 2017 21:53:13 GMT

Another sensible post. I'll 5 star that

RE: Osurnia

Anthony Todd — Sat, 17 Jun 2017 19:56:11 GMT

[quote user="Martin Atkinson"] There are plenty of vets who reach for them inappropriately by default without making a proper diagnosis. As often is the case, the correct way is somewhere in between. [/quote]

All depends on when they are presented, if really early they are just red with increased "wax" [or whatever you call it] in which you will find malazzezia 'cos it lives in normal ears happily, causing no problems, [otherwise how does it get there in "infected" ears].

Leave it a bit longer and 99/100 you'll get pseudomonas and obvious "infection" as well.

and so on.

I'll bet you'll never get "otitis externa" in a normal dog's ear just by squirting a culture of malazzesia into the canal of a normal dog......and probably not with a culture of pseudomonas either.

Irritate it with mites or allergy, increase the production of "wax"; all the bugs shout for joy and multiply like crazy and we've got otitis externa....

Yippe, at least £100plus with a swab, and microscopic instead of a single shot of steroid and some steroid cream [and kill the mites, just in case].

Short explanation about allergy wouldn't go amiss either.....

Just a lack of basic Koch isn't it, or not?

[sigh] Another anonymous one star for sure but, hey ho, Arlo's onto you sooner or later.

RE: Osurnia

Mark Hedberg — Sat, 17 Jun 2017 18:24:59 GMT

[quote user="Martin Atkinson"]

I don't think I've ever been accused of being sensible before!!

[/quote]

That's ok, your secret's safe with us :D

RE: Osurnia

Neil Wheadon — Fri, 16 Jun 2017 18:37:14 GMT

Which brings us nicely to the monthly? Clinical discussions Arlo. I seem to recall ears were on that list, when shall we start?

Neil

RE: Osurnia

Martin Atkinson — Fri, 16 Jun 2017 16:36:36 GMT

[quote user="Bob Russell"]We do cytology almost routinely. [/quote]I do, its quick and costs almost nothing.

[quote user="Bob Russell"]Osurnia really is my first line and I have no plans to change that.[/quote]I guess we'll beg to differ.

RE: Osurnia

Bob Russell — Fri, 16 Jun 2017 16:28:34 GMT

We do cytology almost routinely. Almost never culture and sensitivity! Expensive and pretty much in line with what you would expect from cytology!

I have used Apoquel for itchy ears with good results but generally the nastier ones will get corticosteroids. These ears hurt and it is the quickest way to bring relief if topical products are not enough.

Osurnia really is my first line and I have no plans to change that.